Evidence of meeting #6 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was concussion.
A video is available from Parliament.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
I want to move into the second round starting with Mr. Webber from the Conservatives, but before doing that, I have a quick question.
Dr. Hobden, you brought up that you would like to see some rule changes when it comes to sports. Do you have any clear examples of what rules need to be changed, what rules sports should be changing?
President Elect, Canadian Academy of Sport and Exercise Medicine
It has to be done by the sport, and each sport has to look at this.
My background is in equestrian sports. I'm the national team physician and it took 10 years for us to change that rule. It's the culture; it's slow moving, but it really has to come from within the sport. Sports organizations need to be nudged to look at it and to ask why this is happening in the sport. Why are athletes coming in with the most injuries and the most concussions into the emergency rooms?
For somebody from the outside to come in and say you're going to change your sport like this, I'm not sure how successful that would be.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Mr. Webber, you have five minutes.
Len Webber Calgary Confederation, CPC
Thank you, Mr. Chair. Doctors, thank you for coming today to present.
I'll start with you, Dr. Hobden, on a comment you made in your presentation of a young man who got hurt and didn't know he was concussed. Of course, his academics declined, and his headaches and confusion were evident.
An individual nowadays has that avenue. Back in my day, in the late 1970s and early 1980s.... I know for a fact that I've been concussed numerous times, maybe not as many as you, Dr. Frémont. I don't know whether or not I was dealt a concussion, but I was certainly knocked out.
Being someone who assesses patients—again, this is my first time at this committee so other committee members have probably heard this before but I have not—how do you assess whether someone has had a concussion or not? Being knocked out does not necessarily mean you've had a concussion, correct?
President Elect, Canadian Academy of Sport and Exercise Medicine
Not being knocked out doesn't mean you don't have a concussion, okay?
President Elect, Canadian Academy of Sport and Exercise Medicine
It's a two-way street. It's a complex clinical assessment. You have to take into account the injury. Is it a mechanism that could potentially lead to a concussion? Are there signs and symptoms that are consistent with a concussion.
It's really important to note there's no one test we can do to say that yes, you have a concussion. We can do CT scans and all sorts of magical things to make sure you don't have a more serious brain injury, but there's no one test that we can do.
Calgary Confederation, CPC
You've assessed then that this patient has had a concussion. I'm sorry, and again, you've probably heard this before, but would the treatment be just rest and relaxation? What would the treatment be for someone who has suffered a concussion?
President Elect, Canadian Academy of Sport and Exercise Medicine
For the first three days, it's definitely rest and relaxation. Then we try to increase the activity level gradually. In 90% of patients, in about seven to 10 days, they will be asymptomatic. They'll be able to start a gradual return to sport, learning or work, whatever that is. There's a group that does not progress beyond that and they're the people Dr. Frémont was speaking about before, who need to be triaged to some further care and specialists.
Calgary Confederation, CPC
I see.
Dr. Frémont, can you describe what that care would be then? What would you do for these serious questions?
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
At this point, when you have persistent symptoms, you need to have a careful assessment of different spheres, like the mood disorders that quickly can be part of a concussion. It's very stressful and anxiety can go on to depression. You can have cognitive problems in the cognitive sphere. You can have problems with vision and balance. You can have components that come from cervical injuries. Whether that is a different injury or an associated injury is still being explored and studied.
At this point, the key message is that you need to have the properly composed group of experts design and individualize a treatment plan. The message that comes with that is there is no one specialist or one technology that can take care of every concussion with persistent symptoms.
Calgary Confederation, CPC
Dr. Hobden, you had mentioned also that there's about 531 Canadians who have the speciality that you both have. That sounds quite low to me, of course.
I'll go back to this young man who experiences a concussion. I guess he would just go to his family doctor and they would recommend that he see a specialist, which would then be you. Of course, the wait to get in to see you would probably be quite long, I would think.
President Elect, Canadian Academy of Sport and Exercise Medicine
It depends.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you, Mr. Webber.
We're going to be moving over to the Liberals now. We are very lucky today. This is a subcommittee of the Standing Committee on Health. We have with us today, Mr. Casey, the chair of the health committee, who will be asking a few questions.
Liberal
Bill Casey Liberal Cumberland—Colchester, NS
Thanks very much.
I don't know anything about concussions. What happens in somebody's head when they get a concussion? What actually happens?
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
You know that first period of rest that we recommend—that 48 to 72 hours? The studies on the brain during that period, using animal models and fancy imaging, show that there is a metabolic storm in the brain. There is a problem with the flow of ions in and out of the neurons. There's no focal anatomical bleeding or disruption, but there is disruption at the cellular level and there is a metabolic storm. There is high energy consumption at that point.
It's complex, but the understanding of what's happening is evolving rapidly. Hopefully, at some point we might have ways to act at that very acute stage through intervention, but that's not really possible at this point. The only thing we know that's right to do at this point is to respect that initial period where we limit the physical and cognitive demand on the brain during that storm.
Liberal
Bill Casey Liberal Cumberland—Colchester, NS
When I slipped on the ice about a month ago and fell and hit my head on the back, it could have affected my whole brain, theoretically. It's not just where I hit.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
Yes. It could have been a very bad injury. Some people die from a fall like that because they develop a brain haemorrhage that can sometimes be slow or sometimes fast. Most people will have a concussion with that type of more diffused cellular perturbation, which will last for a few days with the related symptoms.
Liberal
Bill Casey Liberal Cumberland—Colchester, NS
What about the cumulative effect if a person has one concussion and then a second one? If the event is the same, is the concussion worse for the second one, for the third one and the fourth one?
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
I would say that mostly depends on how well you were able to heal from the first one. The worst-case scenario is when you get injured prior to full recovery from the first injury. That's when you see the very dramatic and sad cases of kids who die from recurrence of a head injury after returning to play before being asymptomatic. That's what we don't want.
There is more and more information on the spectrum of what I just described. Without dying, you get those very bad and long-lasting episodes of concussions when you get reinjured prior to healing properly.
On the other side, there's no real indication that if you sustain one concussion, heal from it very well, and make a successful return to the sport you love that you will have residual weakness.
Liberal
Bill Casey Liberal Cumberland—Colchester, NS
It's really important to get the diagnosis right at the time of the first injury. If it's not diagnosed right, then the second concussion could be much worse.
February 20th, 2019 / 6:20 p.m.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
Yes.
Liberal
Bill Casey Liberal Cumberland—Colchester, NS
You said you had concussions. What is the impact of those concussions now? Do you have an impact now from them?